Chinese handwriting performance of primary school children with dyslexia

Dysgraphia Differs Between Children With Developmental Coordination Disorder and/or Reading Disorder

Handwriting deficits, or dysgraphia, are present in several neurodevelopmental disorders. To investigate whether dysgraphia differs according to the associated disorder, we performed a detailed analysis of handwriting in a group of French children with developmental coordination disorders (DCD), reading disorder (RD), or comorbid RD and DCD. Handwriting deficits were investigated at the product (quality of the trace) and the process (movement that generates the trace) levels. Nineteen children with singular RD (among which eight with dysgraphia), 13 children with singular DCD (among which seven with dysgraphia), 16 children with comorbid RD+DCD (among which 11 with dysgraphia), and 20 typically developing children, age 7 to 12, performed the BHK (Brave Handwriting Kinder) test, a standardized assessment of handwriting, on a graphic tablet. Developmental coordination disorders primarily affected handwriting quality, while RD affected slowness and, to a lesser extent, quality. Children with RD, solely or comorbid with DCD, wasted time by lifting and stopping the pen when writing. The comorbidity added to but did not worsen, handwriting difficulties. These results reflect distinct motor impairments and/or strategies in children with DCD or RD. We identified subtypes of dysgraphia and advocated for a fine-grained analysis of the writing process and the assessment of motor and reading skills when studying dysgraphia.

Motor skills and capacities in developmental dyslexia: A systematic review and meta-analysis

In recent decades, the connections between academic skills, such as reading, writing, and calculation, and motor skills/capacities have received increasing attention. Many studies provided evidence for motor difficulties in children and adolescents with dyslexia, prompting the need for a meta-analysis to combine these multiple findings. Therefore, we conducted a meta-analysis using PsycINFO, Pubmed, and SportDiscus as scientific databases. A total of 572 studies were analyzed following several stringent inclusion criteria, resulting in the inclusion of 23 peer-reviewed studies in the final analysis. Our results showed that children and adolescents with dyslexia displayed significant different performances in multiple motor tasks and these differences persisted also when the type of motor task was considered as moderator in the analysis. The present findings are in accordance with the literature that supports a close connection between reading disabilities and difficulties in motor skills/capacities.

DysDiTect: Dyslexia Identification Using CNN-Positional-LSTM-Attention Modeling with Chinese Dictation Task

Handwriting difficulty is a defining feature of Chinese developmental dyslexia (DD) due to the complex structure and dense information contained within compound characters. Despite previous attempts to use deep neural network models to extract handwriting features, the temporal property of writing characters in sequential order during dictation tasks has been neglected. By combining transfer learning of convolutional neural network (CNN) and positional encoding with the temporal-sequential encoding of long short-term memory (LSTM) and attention mechanism, we trained and tested the model with handwriting images of 100,000 Chinese characters from 1064 children in Grades 2-6 (DD = 483; Typically Developing [TD] = 581). Using handwriting features only, the best model reached 83.2% accuracy, 79.2% sensitivity, 86.4% specificity, and 91.2% AUC. With grade information, the best model achieved 85.0% classification accuracy, 83.3% sensitivity, 86.4% specificity, and 89.7% AUC. These findings suggest the potential of utilizing machine learning technology to identify children at risk for dyslexia at an early age.

Reliability, validity, and measurement invariance of a Chinese handwriting legibility scale among primary students in central China

Background

Chinese handwriting has a close relationship with spatial cognition, and the legibility dimension is prominent with its spatial-oriented characteristics. However, handwriting evaluation focusing on the detailed spatial aspects of the legibility dimension in the Chinese context is rare.

Aims and methods

We aimed to develop a Chinese Handwriting Legibility Scale (CHLS) and examine its reliability, validity, and measurement invariance among Chinese primary students of different grades. A total of 684 students aged 8-12 years were recruited from a mainstream primary school in central China and were asked to copy a Chinese template as legibly as possible within 4 min. The developed CHLS was used to assess these students' legibility performance.

Results

The seven-criteria CHLS favored content validity. The inter-rater reliability was good; however, the scoring instructions need to be refined. Principal component analysis (PCA) revealed a one-factor solution explaining 62.336% of the variance of the seven-criteria CHLS, and confirmatory factor analysis (CFA) confirmed its appropriateness. There was a high internal consistency (α = 0.902). In terms of measurement invariance, the factor structures and loadings of the CHLS were consistent across students of different grades; however, significant intercept variations were detected between students of Grades 2 and 4.

Conclusion

CHLS may be effective for evaluating Chinese handwriting legibility performance in the Chinese primary school context in the central region. Students' Chinese handwriting legibility performance may have developmental specificity in different grades.

In a split second: Handwriting pauses in typical and struggling writers

Introduction

A two-second threshold has been typically used when analyzing the writing processes. However, there is only a weak empirical basis to claim that specific average numbers and durations of pauses may be associated with specific writing processes. We focused on handwriting execution pauses, because immature writers are known to struggle with transcription skills. We aimed to provide an evidence-based account of the average number and duration of handwriting pauses in the mid-Primary grades and to identify process-level markers of writing difficulties.

Methods

Eighty 3rd and 5th graders, with and without writing difficulties, participated in the study. We examined pauses in a handwriting-only task, to be able to isolate those which could only be attributed to handwriting processes. Letter features were considered, as well as children's handwriting fluency level.

Results

The average duration of handwriting pauses was around 400ms, in line with assumptions that transcription pauses would fall under the 2,000ms threshold. We found that 3rd graders made more and longer pauses than 5th graders. Struggling writers made a similar number of pauses across grades than typically-developing children, although they were significantly longer, even after controlling for the effect of handwriting fluency.

Discussion

Our findings provide an evidence-based account of the duration of handwriting pauses. They also suggest that children need fewer and shorter handwriting pauses as they progress in automatizing transcription. However, some young writers struggle with letter formation even after 3 to 5 years of instruction.

Development and Psychometric Evaluation of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) for School-Age Children

IMPORTANCE

Handwriting legibility is the main criterion for determining whether a child has handwriting difficulties. A comprehensive assessment of handwriting legibility with sound psychometrics is essential to timely identification of handwriting difficulties and outcome measurement after handwriting interventions.

OBJECTIVE

To evaluate the psychometrics of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) and to investigate Chinese handwriting legibility in school-age children using the CAM-CHL.

DESIGN

Cross-sectional, repeated observation, test-retest.

SETTING

Elementary schools in Taiwan.

PARTICIPANTS

We recruited 25 lower-grade children for the examination of test-retest reliability, 75 children from all grade levels, and 10 senior schoolteachers for the examination of the CAM-CHL's convergent validity and the investigation of handwriting legibility.

OUTCOMES AND MEASURES

Children were asked to copy a set of Chinese characters as legibly as possible. We used the CAM-CHL to assess handwriting legibility in four domains: Size, Orientation, Position, and Deformation. The schoolteachers were asked to subjectively assess the handwriting legibility using a 3-point Likert-type scale.

RESULTS

The CAM-CHL demonstrated good to excellent test-retest reliability and acceptable random measurement error in all legibility domains. The CAM-CHL had fair to moderate convergent validity with schoolteachers' perceptions. Additionally, upper-grade children had better handwriting legibility in the Size and Position domains than lower-grade children.

CONCLUSIONS AND RELEVANCE

The CAM-CHL, a comprehensive and objective method of assessing Chinese handwriting legibility, has sound reliability and acceptable validity, suggesting its potential as an outcome measure for school-age children. What This Article Adds: The CAM-CHL can be used in comprehensive evaluations of Chinese handwriting legibility in school-age children. The CAM-CHL has acceptable psychometrics for use as an outcome measure.

Working Memory and Manual Dexterity in Dyslexic Children: A Systematic Review and Meta-Analysis

Dyslexic children have impairments in working memory and manual dexterity. Studies have shown that when cognitive development has deficits, motor development is often impaired, indicating a strong interconnection between both domains, and the possibility of interference with each other's proper functioning. Thus, a new literature review is necessary to understand which components of working memory and manual dexterity are affected in dyslexic children and the possible relationship between them. This review aimed to perform a systematic review and meta-analysis to analyze both skills in dyslexic children. The protocol was carried out according to the criteria established by PRISMA being registered at PROSPERO under number CRD 42021238901. Six literature databases were searched to locate studies published between 2001 and 2021: EMBASE, ERIC, ISI Web of Science, PubMed, PsycINFO, and Scopus. 21 studies met the inclusion criteria. The findings suggest that dyslexic children have significantly poorer visuospatial and verbal working memory with more impairments in the phonological loop. No significant differences were found in manual dexterity.

Computerized handwriting evaluation and statistical reports for children in the age of primary school

This study proposed a novel computational method for evaluating logographic handwriting. It can precisely evaluate both the handwriting product and the process. The measures included handwriting performance as well as the temporospatial, kinematics, and kinetics features. For examining the psychometrics of this comprehensive evaluation system, typical development children aged 6 to 9 years old (grade 1 to grade 3) (n = 641) were involved in the study of factor analysis. From twelve measuring variables, the exploratory factor analysis extracted five factors (handwriting performance, motor control, speed and automation, halt and exertion, and “in air” events). The test reliability was confirmed by further recruitment of typically developing children (n = 242). The internal consistency mostly demonstrated good to excellent results for every measure. This study further recruited children with handwriting difficulties (n = 33) for testing the discriminative validity of the evaluation system. A series of two-way ANOVA tests was conducted to test the significance of the main effects of the groups (typical development and handwriting deficit) and grades (1, 2, and 3) and their interaction effects on the handwriting measures. All the measures showed significant differences between the two groups, indicating the discriminative validity for identifying handwriting deficits. Seven of twelve measures showed significant interaction effects, indicating the different trends across the grades between the two groups. Typically-developing children demonstrated ongoing progress from grade 1 to grade 3, suggesting a developmental trend during their early school age. Implications for motor development and clinical evaluation are discussed herein in relation to the five dimensions.

Disruption of Functional Brain Networks Underlies the Handwriting Deficit in Children With Developmental Dyslexia

Developmental dyslexia (DD) is a neurological-based learning disorder that affects 5-17.5% of children. Handwriting difficulty is a prevailing symptom of dyslexia, but its neural mechanisms remain elusive. Using functional magnetic resonance imaging (fMRI), this study examined functional brain networks associated with handwriting in a copying task in Chinese children with DD (n = 17) and age-matched children (n = 36). We found that dyslexics showed reduced network connectivity between the sensory-motor network (SMN) and the visual network (VN), and between the default mode network (DMN) and the ventral attention network (VAN) during handwriting, but not during drawing geometric figures. Moreover, the connectivity strength of the networks showing group differences was correlated with handwriting speed, reading and working memory, suggesting that the handwriting deficit in DD is linked with disruption of a large-scale brain network supporting motoric, linguistic and executive control processes. Taken together, this study demonstrates the alternations of functional brain networks that underly the handwriting deficit in Chinese dyslexia, providing a new clue for the neural basis of DD.

The performance and predictors of Chinese character writing in children with attention deficit hyperactivity disorder

Writing difficulties are common in children with attention deficit hyperactivity disorder (ADHD). Preliminary evidence suggests that early character writing ability is fundamental for later writing composition and academic achievement. Critical factors of different character writing tasks in children with ADHD, however, remain unclear. This study aims to describe the performance and identify predictors of Chinese character writing in children with ADHD. Thirty Mandarin Chinese-speaking children with ADHD (7.16 ± 0.59 years) and thirty matched peers (7.21 ± 0.57 years) were recruited from northern Taiwan. They were evaluated with the Battery of Chinese Basic Literacy (BCBL); the Chinese version of the Test of Nonverbal Intelligence, fourth edition (C-TONI-4); the Chinese version of the Peabody Picture Vocabulary Test-Revised (C-PPVT-R); orthographic awareness test; character naming test; and the Bruininks Oseretsky Test of Motor Proficiency, second edition (BOT-2). The results showed that Mandarin Chinese-speaking children with ADHD scored lower than their typically developing peers on both dictation and copying subtests. After controlling for age, orthographic awareness and inattention were identified as important predictors of character dictation; while, manual dexterity was a critical predictor of character copying in children with ADHD. The results demonstrated that character writing problems may exist in Mandarin Chinese-speaking children with ADHD, and cognitive-linguistic and fine-motor skills have varying contributions to Chinese character writing tasks.

Specific Learning Disorder in Children and Adolescents, a Scoping Review on Motor Impairments and Their Potential Impacts

Mastering motor skills is important for children to achieve functional mobility and participate in daily activities. Some studies have identified that students with specific learning disorders (SLD) could have impaired motor skills; however, this postulate and the potential impacts remain unclear. The purpose of the scoping review was to evaluate if SLD children have motor impairments and examine the possible factors that could interfere with this assumption. The sub-objective was to investigate the state of knowledge on the lifestyle behavior and physical fitness of participants with SLD and to discuss possible links with their motor skills. Our scoping review included preregistration numbers and the redaction conformed with the PRISMA guidelines. A total of 34 studies published between 1990 and 2022 were identified. The results of our scoping review reflected that students with SLD have poorer motor skills than their peers. These motor impairments are exacerbated by the complexity of the motor activities and the presence of comorbidities. These results support our sub-objective and highlight the link between motor impairments and the sedentary lifestyle behavior of SLDs. This could lead to deteriorating health and motor skills due to a lack of motor experience, meaning that this is not necessarily a comorbidity. This evidence emphasizes the importance of systematic clinical motor assessments and physical activity adaptations.

Curved vs. Straight-Line Handwriting Effects on Word Recognition in Typical and Dyslexic Readers Across Chinese and English

Handwriting serves to link auditory and motor routines with visual word processing, which is a hallmark of successful reading. The current study aims to explore the effect of multisensory integration as a pathway to neural specialization for print among typical and dyslexic readers across writing systems. We identified 9-10-year-old dyslexic Chinese children (n = 24) and their typically developing counterparts (n = 24) on whom we conducted both behavioral and electroencephalogram (EEG) experiments. We designed four learning conditions: Handwriting Chinese (HC), Viewing Chinese (VC), Drawing followed by Character Recognition in Chinese (D-C), and Drawing followed by Word Recognition in English (D-E). In both handwriting and drawing conditions, we also designed curved vs. straight-line stimuli. Both behavioral and EEG results showed that handwriting straight line strokes facilitated visual word recognition in Chinese compared to handwriting curved lines. Handwriting conditions resulted in a lateralization of the N170 in typical readers, but not the dyslexic readers. Interestingly, drawing curved lines facilitate word recognition in English among dyslexic readers. Taken together, the results of the study suggest benefits of handwriting on the neural processing and behavioral performance in response to Chinese character recognition and curved-line drawing effects on English word recognition among dyslexic readers. But the lack of handwriting effects in dyslexic readers suggest that students who have deficits in reading may also be missing the link between multisensory integration and word recognition in the visual word form areas. The current study results have implications for maintaining handwriting practices to promote perception and motor integration for visual word form area development for normal readers and suggest that drawing practices might benefit Chinese dyslexic readers in reading English.

The brain basis of handwriting deficits in Chinese children with developmental dyslexia

Abundant behavioral studies have demonstrated high comorbidity of reading and handwriting difficulties in developmental dyslexia (DD), a neurological condition characterized by unexpectedly low reading ability despite adequate nonverbal intelligence and typical schooling. The neural correlates of handwriting deficits remain largely unknown; however, as well as the extent that handwriting deficits share common neural bases with reading deficits in DD. The present work used functional magnetic resonance imaging to examine brain activity during handwriting and reading tasks in Chinese dyslexic children (n = 18) and age-matched controls (n = 23). Compared to controls, dyslexic children exhibited reduced activation during handwriting tasks in brain regions supporting sensory-motor processing (including supplementary motor area and postcentral gyrus) and visual-orthography processing (including bilateral precuneus and right cuneus). Among these regions, the left supplementary motor area and the right precuneus also showed a trend of reduced activation during reading tasks in dyslexics. Moreover, increased activation was found in the left inferior frontal gyrus and anterior cingulate cortex in dyslexics, which may reflect more efforts of executive control to compensate for the impairments of motor and visual-orthographic processing. Finally, dyslexic children exhibited aberrant functional connectivity among brain areas for cognitive control and sensory-motor processes during handwriting tasks. Together, these findings suggest that handwriting deficits in DD are associated with functional abnormalities of multiple brain regions implicated in motor execution, visual-orthographic processing, and cognitive control, providing important implications for the diagnosis and treatment of dyslexia.

Cross-cultural Validation of the Full Range Test of Visual Motor Integration Used with Children in Four Arab Countries

SIGNIFICANCE

Arab countries have a shortage of culturally sensitive psychoeducational assessments. Tests of visual-motor integration are low in their linguistic demands, yet they are not culture-free.

PURPOSE

The aim of this study was to explore the psychometric properties and the validation of the Full Range Test of Visual Motor Integration (FRTVMI) across four Arabic speaking countries, namely, Sultanate of Oman, Kuwait, Qatar, and the Kingdom of Saudi Arabia (n = 2318).

METHODS

The FRTVMI was administered to 2318 children from four Gulf countries. Criterion measures included the Reading Observation Scale and the achievement scores in reading. All raw data obtained for the FRTVMI were analyzed using the Statistical Package for Social Sciences and R package (version 3.5.1, 2018). Construct validity was examined using confirmatory factor analysis. The internal consistency, test-retest reliability, and interrater reliability of FRTVMI were also examined.

RESULTS

The means for Cronbach α, intraclass correlation, and test-retest reliability across the four countries were 0.87, 0.87, and 0.90, respectively. Spearman ρ correlation between FRTVMI scores and Reading Observation Scale scores ranged between 0.16 and 0.51 across the four countries and were 0.57, 0.43, and 0.45 for male and female participants and the entire sample, respectively. The Spearman ρ correlations between FRTVMI scores and reading achievement scores ranged between 0.15 and 0.20 across the four countries and were 0.27, 0.29, and 0.26 for male and female participants and the entire sample, respectively. The modified model indices showed that the FRTVMI was adequate for use in the four countries and for both male and female participants. The reliability estimates for the test were high, whereas the concurrent validity estimates were moderate.

CONCLUSIONS

The unidimensionality of the test should be taken with caution, as we found some indication for the multidimensionality of the test factor structure. Implications for cross-cultural assessment are discussed.

Timing anticipation in adults and children with Developmental Dyslexia: evidence of an inefficient mechanism

Developmental Dyslexia (DD) is a learning disorder characterized by specific difficulties in learning to read accurately and fluently, which has been generally explained in terms of phonological deficits. Recent research has shown that individuals with DD experience timing difficulties in the domains of language, music perception and motor control, probably due to impaired rhythmic perception, suggesting that timing deficit might be a key underlying factor to explain such a variety of difficulties. The present work presents two experiments aimed at assessing the anticipatory ability on a given rhythm of 9-year old Italian children and Italian adults with and without DD. Both adults and children with DD displayed a greater timing error and were more variable than controls in high predictable stimuli. No difference between participants with and without DD was found in the control condition, in which the uncertain timing of the beat did not permit the extraction of regularities. These results suggest that both children and adults with DD are unable to exploit temporal regularities to efficiently anticipate the next sensory event whereas control participants easily are. By showing that the anticipatory timing system of individuals with Developmental Dyslexia appears affected, this study adds another piece of evidence to the multifaceted reality of Developmental Dyslexia.

Who Benefits from An Intervention Program on Foundational Skills for Handwriting Addressed to Kindergarten Children and First Graders?

This study examined the effectiveness of a 10-wk intervention program based on occupational therapy principles on visual-motor integration skills and fine motor abilities in kindergartners and first graders. We recruited 55 students tested three times with the Visual-Motor Integration Test (VMI) and Movement Assessment Battery for Children-2 (MABC-2): before the intervention (T1), post-intervention (T2) and one month later (T3). Research findings: Significant improvements were found on VMI between T1 and T2, particularly for kindergartners. Neither group of children demonstrated changes on manual dexterity scores. The present study showed that the intervention program led to different changes in the at-risk of motor impairment group than in the not at-risk children. Results indicated that games and stimulation activities helped children below the 16th percentile over time in the manual dexterity domain. A gender effect was observed, with female children increasing their abilities over time more than male peers. Future research should concentrate on stimulating fine motor skills in hand manipulation and test how these abilities influence graphomotor skills and handwriting over time. Finally, more research is needed to determine the impact of activities and games carried out in educational settings.

Reliability and validity of Handwriting Test for Preschool Children (HT-PRE): A new tool to assess the handwriting ability of preschool children aged 5-6 years old in Mainland China

BACKGROUND

Handwriting ability is related to many neuronal functions, such as visual-perceptual skills, orthographic coding, motor planning and execution, kinesthetic feedback and visual-motor coordination. To date, there is no specific assessment tool for to assess preschool children's handwriting ability in Mainland China. Our study aimed to develop a tool to assess the handwriting ability of children aged 5-6 years old in Mainland China and to analyze its reliability and validity.

METHODS

The investigation comprised three phases: 1) original tool generation, 2) tool revision, 3) reliability analysis (i.e., interrater, test-retest) and validity analysis (i.e., content, criterion).

RESULTS

The sample included a total of 482 children. The internal consistency (Cronbach alpha) was 0.74. The test-retest correlation coefficients ranged from 0.38 to 0.80. As expected, our data showed an improving trend in handwriting, and differences in respect to age and gender. When compared with the 'handwriting difficulty' group, each subtest score of children in the 'normal' group showed significant differences (p < 0.05). The correlation validity, compared with the visual-motor integration development test (VMI), was 0.17-0.52.

CONCLUSION

The Handwriting Test for Preschool Children (HT-PRE), which is a newly developed handwriting screening tool for preschool children aged 5-6 years old in Mainland China, has displayed a very good internal consistency, acceptable test-retest reproducibility, and good criterion-based validity, and has also shown good application prospects for handwriting difficulty screening in a clinical setting.

Evaluation of the Reliability and Validity of the Brazilian Version of the Here’s How I Write:

OBJECTIVE. Our objective was to translate the Here’s How I Write: A Child’s Self-Assessment and Goal Setting Tool (HHIW) to Portuguese; adapt it to the Brazilian culture; and analyze its reliability, validity, and clinical feasibility.

METHOD. The study was developed in two steps: adaptation of the HHIW to Brazilian Portuguese, followed by experimental application to examine its validity and reliability. The participants were 60 children and their teachers, divided into two groups: Group 1, whose members had handwriting difficulties, and Group 2, whose members did not.

RESULTS. Children with poor handwriting scored lower on the HHIW for both self- and teacher report. Test–retest reliability of the children’s (.96) and teachers’ (.93) questionnaires as well as internal consistency (.91 and .95, respectively) were excellent. There was good agreement (.74) between the children’s and teachers’ total scores.

CONCLUSIONS. This study adds further evidence of validity and reliability and supports the international use of the HHIW. The HHIW is a useful resource to engage children and teachers in a collaborative relationship to improve handwriting.

Developmental skills between kindergarten children with handwriting difficulties in Chinese and/or English

AIM

This study aimed to examine the differences in developmental skills between children with and without handwriting difficulties in their last year of kindergarten education.

METHODS

Standardised tests on handwriting performance and developmental skills were administered to 20 typically developing children, 21 children with handwriting difficulties in Chinese and 23 children with handwriting difficulties in both Chinese and English. We used one-way MANOVA, univariate ANOVA and post hoc comparisons, to compare the developmental skills between children with and without handwriting difficulties. Multiple regression analysis was used to identify the significant predictors of developmental skills for Chinese and English handwriting performance.

RESULTS

Higher proportion of children faced handwriting difficulties in Chinese than in English. Their major problem in Chinese handwriting was on stroke formation, while the results did not indicate the key factor leading to English handwriting difficulties. The results also showed that children with handwriting difficulties had significantly poorer visual motor integration, some aspects of visual perception and fine motor skills than typically developing children. Reading skills were not a key factor contributing to handwriting performance. In addition, visual and fine motor integration and spatial relationship were the significant predictors of Chinese and English handwriting performance, which accounted for 39.7 and 43.6% of the variance respectively.

CONCLUSION

First, the results suggested that more resources should be devoted to coaching children to learn Chinese than English handwriting. Second, besides direct repetitive practice on handwriting, there is a need to incorporate learning activities to facilitate the development of visual motor skills, visual perception, and fine motor skills as a preparation for learning to write or in improving handwriting performance among kindergarten children.

Reading and Writing Skills in Children With Specific Learning Disabilities With and Without Developmental Coordination Disorder

This pilot study is to investigate the influence of a developmental coordination disorder (DCD) comorbidity in a group of children with learning disability (LD). Reading and writing were assessed to investigate if the coexistence of a motor impairment can worsen writing quality, speed, and reading accuracy. A sample of 33 LD children (aged 7-11 years) was divided in two subgroups, on the base of their scores on the Movement Assessment Battery for Children: LD-only (n = 14) and LD with a comorbidity for DCD (LD-DCD, n = 19). No differences were found in handwriting speed, but significant differences were found in handwriting quality: LD-DCD children showed a worst performance. Reading words and nonwords accuracy was more impaired in LD-only children than in LD-DCD children. Group differences suggest a poorer phonological decoding of the LD-only sample, whereas worst cursive handwriting legibility scores are typical of the motor-impaired subgroup.

Exploring the Link between Visual Perception, Visual-Motor Integration, and Reading in Normal Developing and Impaired Children using DTVP-2

Reading is known to be primarily a linguistic task. However, to successfully decode written words, children also need to develop good visual-perception skills. Furthermore, motor skills are implicated in letter recognition and reading acquisition. Three studies have been designed to determine the link between reading, visual perception, and visual-motor integration using the Developmental Test of Visual Perception version 2 (DTVP-2). Study 1 tests how visual perception and visual-motor integration in kindergarten predict reading outcomes in Grade 1, in typical developing children. Study 2 is aimed at finding out if these skills can be seen as clinical markers in dyslexic children (DD). Study 3 determines if visual-motor integration and motor-reduced visual perception can distinguish DD children according to whether they exhibit or not developmental coordination disorder (DCD). Results showed that phonological awareness and visual-motor integration predicted reading outcomes one year later. DTVP-2 demonstrated similarities and differences in visual-motor integration and motor-reduced visual perception between children with DD, DCD, and both of these deficits. DTVP-2 is a suitable tool to investigate links between visual perception, visual-motor integration and reading, and to differentiate cognitive profiles of children with developmental disabilities (i.e. DD, DCD, and comorbid children). Copyright © 2017 John Wiley & Sons, Ltd.

Predicting Handwriting Legibility in Taiwanese Elementary School Children

This study investigates handwriting characteristics and potential predictors of handwriting legibility among typically developing elementary school children in Taiwan. Predictors of handwriting legibility included visual-motor integration (VMI), visual perception (VP), eye-hand coordination (EHC), and biomechanical characteristics of handwriting. A total of 118 children were recruited from an elementary school in Taipei, Taiwan. A computerized program then assessed their handwriting legibility. The biomechanics of handwriting were assessed using a digitizing writing tablet. The children's VMI, VP, and EHC were assessed using the Beery-Buktenica Developmental Test of Visual-Motor Integration. Results indicated that predictive factors of handwriting legibility varied in different age groups. VMI predicted handwriting legibility for first-grade students, and EHC and stroke force predicted handwriting legibility for second-grade students. Kinematic factors such as stroke velocity were the only predictor for children in fifth and sixth grades.

Handwriting Development in Spanish Children With and Without Learning Disabilities: A Graphonomic Approach

The central purpose of this study was to analyze the dynamics of handwriting movements in real time for Spanish students in early grades with and without learning disabilities. The sample consisted of 120 children from Grades 1 through 3 (primary education), classified into two groups: with learning disabilities and without learning disabilities. The Early Grade Writing Assessment tasks selected for this purpose were writing the alphabet in order from memory, alphabet copying in cursive and manuscript, and allograph selection. The dynamics of these four handwriting tasks were recorded using graphonomic tablets (type Wacom Intuos-4), Intuos Inking pens, and Eye and Pen 2 software. Several events were recorded across four different tasks: velocity, pressure, time invested in pauses, and automaticity. The results demonstrated significant graphonomic variations between groups across grades, depending on the type of task.

Functional and anatomical dissociation between the orthographic lexicon and the orthographic buffer revealed in reading and writing Chinese characters by fMRI

The contribution of orthographic representations to reading and writing has been intensively investigated in the literature. However, the distinction between neuronal correlates of the orthographic lexicon and the orthographic (graphemic) buffer has rarely been examined in alphabetic languages and never been explored in non-alphabetic languages. To determine whether the neural networks associated with the orthographic lexicon and buffer of logographic materials are comparable to those reported in the literature, the present fMRI experiment manipulated frequency and the stroke number of Chinese characters in the tasks of form judgment and stroke judgment, which emphasized the processing of character recognition and writing, respectively. It was found that the left fusiform gyrus exhibited higher activation when encountering low-frequency than high-frequency characters in both tasks, which suggested this region to be the locus of the orthographic lexicon that represents the knowledge of character forms. On the other hand, the activations in the posterior part of the left middle frontal gyrus and in the left angular gyrus were parametrically modulated by the stroke number of target characters only in the stroke judgment task, which suggested these regions to be the locus of the orthographic buffer that represents the processing of stroke sequence in writing. These results provide the first evidence for the functional and anatomical dissociation between the orthographic lexicon and buffer in reading and writing Chinese characters. They also demonstrate the critical roles of the left fusiform area and the frontoparietal network to the long-term and short-term representations of orthographic knowledge, respectively, across different orthographies.

Handwriting Proficiency Screening Questionnaire for Children (HPSQ–C): Development, Reliability, and Validity

OBJECTIVE. To adapt the Handwriting Proficiency Screening Questionnaire (HPSQ), previously designated for adults, into a children’s self-report version (the HPSQ for Children, or HPSQ–C) and to examine its reliability and validity.

METHOD. Participants included 230 children ages 7–14 yr from regular schools in Israel. The questionnaire’s content validity, internal consistency, and concurrent and construct validity were assessed.

RESULTS. The tool demonstrated good internal consistency (α = .77). We found a significant moderate correlation between final HPSQ–C scores and the HPSQ, r = .51, p &lt; .001, establishing the HPSQ–C’s concurrent validity. Construct validity was also confirmed. Results demonstrated that the HPSQ–C significantly distinguished between children with and without handwriting deficiencies on the basis of measures of handwriting product (Hebrew Handwriting Evaluation) and handwriting process (Computerized Penmanship Evaluation Tool).

CONCLUSION. The HPSQ–C is suitable for identification of handwriting deficiency among school-aged children and is appropriate for varied academic and clinical uses.

Writing to dictation and handwriting performance among Chinese children with dyslexia: relationships with orthographic knowledge and perceptual-motor skills

The purpose of this study was to investigate the relationships between writing to dictation, handwriting, orthographic, and perceptual-motor skills among Chinese children with dyslexia. A cross-sectional design was used. A total of 45 third graders with dyslexia were assessed. Results of stepwise multiple regression models showed that Chinese character naming was the only predictor associated with word dictation (β=.32); handwriting speed was related to deficits in rapid automatic naming (β=-.36) and saccadic efficiency (β=-.29), and visual-motor integration predicted both of the number of characters exceeded grid (β=-.41) and variability of character size (β=-.38). The findings provided support to a multi-stage working memory model of writing for explaining the possible underlying mechanism of writing to dictation and handwriting difficulties.

Validation of the Chinese Handwriting Analysis System (CHAS) for primary school students in Hong Kong

There are more children diagnosed with specific learning difficulties in recent years as people are more aware of these conditions. Diagnostic tool has been validated to screen out this condition from the population (SpLD test for Hong Kong children). However, for specific assessment on handwriting problem, there seems a lack of standardized and objective evaluation tool to look into the problems. The objective of this study was to validate the Chinese Handwriting Analysis System (CHAS), which is designed to measure both the process and production of handwriting. The construct validity, convergent validity, internal consistency and test-retest reliability of CHAS was analyzed using the data from 734 grade 1-6 students from 6 primary schools in Hong Kong. Principal Component Analysis revealed that measurements of CHAS loaded into 4 components which accounted for 77.73% of the variance. The correlation between the handwriting accuracy obtained from HAS and eyeballing was r=.73. Cronbach's alpha of all measurement items was .65. Except SD of writing time per character, all the measurement items regarding handwriting speed, handwriting accuracy and pen pressure showed good to excellent test-retest reliability (r=.72-.96), while measurement on the numbers of characters which exceeded grid showed moderate reliability (r=.48). Although there are still ergonomic, biomechanical or unspecified aspects which may not be determined by the system, the CHAS can definitely assist therapists in identifying primary school students with handwriting problems and implement interventions accordingly.

Handwriting movement analyses comparing first and second graders with normal or dysgraphic characteristics

Dysgraphia of sufficient severity to interfere with the school work has been recognized as representing a distinct deficit; characterization of its movement problem is a necessary step toward offering improved intervention. From among children aged 6-8, 69 children with dysgraphic characteristics (study group) and 69 matched proficient hand-writers (control group) were recruited into this study. Four copying tests of differing complexity levels were administered using a digital tablet. The acquired data included direct measure (axial pen tip force) and derived parameters (stroke velocity, pause time, number of velocity peaks and ratio of In Air to On Paper measures). The major finding is that children with dysgraphic characteristics had increased pause time per stroke and an increased number of directional changes in velocity. Significant differences were also found between students in two different grades, especially in the control group. The parameters extracted and observed in this study can further differentiate and characterize the handwriting problems originating from fine motor deficits.

An investigation of visual contour integration ability in relation to writing performance in primary school students

A previous study found a visual deficit in contour integration in English readers with dyslexia (Simmers & Bex, 2001). Visual contour integration may play an even more significant role in Chinese handwriting particularly due to its logographic presentation (Lam, Au, Leung, & Li-Tsang, 2011). The current study examined the relationship between children's performance in visual contour (VC) integration and Chinese handwriting. Twenty students from grade 3 to grade 6 were recruited (M=9.51, SD=1.02) from a mainstream primary school using the convenience sampling method. Ten students were identified by teachers as having handwriting problems, and the other 10 were typical students. Participants performed the VC tasks and their handwriting performance was assessed by a Chinese Handwriting Assessment Tool (CHAT) in a classroom setting. Correlation analyses revealed that VC accuracy was significantly and negatively correlated with on paper time and total writing duration. t-Test analyses revealed statistically significant differences in VC accuracy between students with typical and poor handwriting, with consistently better VC accuracy performance in all conditions in the typical handwriting group. The results may have important implications for interventions aiming at improving children's handwriting.